by Fergus Walsh | Medical correspondent

In all the furore about the banned PIP breast implants, one question remains unanswered: are they safe?

The Commons Health Select Committeetalks of a striking “absence of evidence” over safety issues.

In January an expert group headed by Sir Bruce Keogh confirmed categorically that there was no higher cancer risk from PIP implants compared to other devices.

But the committee did not have enough evidence to rule conclusively on the PIP rupture rate compared to other implants, nor whether they were more difficult to remove than other devices following a rupture.

The French authorities did report both higher rupture rates and spoke of the risks of inflammation in the surrounding tissue.

MPs on the Health Committee say the absence of evidence meant the policy response became one of judgement and caution rather than scientific imperative. This explains why the French have advised routine removal of all PIP implants and the British have not.

The French – and Germans – argue that this is a sensible precaution because of the long-term doubts over the safety of the implants and the lack of knowledge about the composition of the gel filler that was used.

Toxicological tests on the PIP filler material have so far not yielded any clear concerns about the filler compared with other silicone implants. So the advice here is that routine removal is not advisable.

Critical

The Health Committee is critical of the MHRA and the Department of Health for not doing more on this issue between March 2010 and December 2011.

The earlier date was when the implants were banned. The MHRA put out a fairly bland press notice on 31 March 2010 and the issue attracted some publicity over the coming months, but not a great deal.

In September 2010 the MHRA released what it called “encouraging”results of UK testing of PIP implants which found no evidence of cancer risk nor of chemical toxicity.

The Commons Health Committee says a high-profile response should have been adopted here sooner and criticises the action taken after March 2010 as inadequate. In particular the MPs say private clinics had a duty to contact patients directly and the MHRA and Department of Health should have raised public awareness.

It was not until December 2011, when the French authorities recommended all women there have the implants removed, that the issue exploded across the media.

So where does this leave women who have PIP implants?

What they need is certainty as to whether the devices inside them pose any significant health risk, and at present Sir Bruce Keogh’s Expert Group says there is no solid evidence of that.

The Health Committee says that “some further evidence has been emerging about the inflammatory properties of the PIP implants whether ruptured or not” and this should be examined urgently.

It concludes that if the surgery to take out ruptured PIP implants involves “significant complications”, then this would be an argument for recommending early removal.

It is worth bearing in mind that every implant has a finite life-span – the figure of 10 years is a crude estimate – and many women may be biding their time about when they choose to have surgery.

The Health Committee said the refusal of the NHS in England to allow women to pay for new implants during surgery to remove the PIP devices was deterring some from taking action.

Latest figures from the Department of Health reveal that more than 5,000 private PIP patients have been referred for a specialist NHS consultation, and more than 3,000 have been scanned.

About one in five women going through the NHS route have decided to have the implants removed. What is not clear is the proportion who decide to seek private treatment to replace implants and the numbers choosing to take no further action.

All, I’m sure, would welcome definitive health guidance from the expert group as soon as possible.

http://www.bbc.co.uk/news/health-17539171

A chemical found in curry is to be tested for its ability to kill bowel cancer tumours in patients.

Curcumin, which is found in the spice turmeric, has been linked to a range of health benefits.

Studies have already shown that it can beat cancer cells grown in a laboratory and benefits have been suggested in stroke and dementia patients as well.

Now a trial at hospitals in Leicester will investigating giving curcumin alongside chemotherapy drugs.

About 40,000 people are diagnosed with bowel cancer in the UK each year.

If the disease spreads around the body, patients are normally given a combination of three chemotherapy drugs, but about half will not respond.

Forty patients at Leicester Royal Infirmary and Leicester General Hospital will take part in the trial, which will compare the effects of giving curcumin pills seven days before starting standard chemotherapy treatment.

‘Difficult to treat’

Prof William Steward, who is leading the study, said animal tests combining the two were “100 times better” than either on their own and that had been the “major justification for cracking on” with the trial.

He said: “Once bowel cancer has spread it is very difficult to treat, partly because the side effects of chemotherapy can limit how long patients can have treatment.

“The prospect that curcumin might increase the sensitivity of cancer cells to chemotherapy is exciting because it could mean giving lower doses, so patients have fewer side effects and can keep having treatment for longer.

“This research is at a very early stage, but investigating the potential of plant chemicals to treat cancer is an intriguing area that we hope could provide clues to developing new drugs in the future.”

Joanna Reynolds, from Cancer Research UK, said: “By doing a clinical trial like this, we will find out more about the potential benefits of taking large amounts of curcumin, as well as any possible side effects this could have for cancer patients.”

http://www.bbc.co.uk/news/health-17959521

By Nanci Hellmich, USA TODAY

John Hoffman isn’t a doctor. He doesn’t even play one on TV.

But come May 14, he’ll unveil a diagnosis, of sorts, for dealing with obesity as executive producer of The Weight of the Nation, a new four-part HBO documentary.

The production, done in conjunction with the Institute of Medicine, which provides independent advice on health, features dozens of top experts exploring the causes and solutions for obesity in the USA.

“The aim is to sound a very loud alarm — to say, we have enough evidence about the terrible toll obesity is exacting on individuals, our communities and our society,” Hoffman says. “The consequences of not acting, boldly, systemically and decisively, are dire.”

Excess weight is linked to an increased risk of heart disease, type 2 diabetes, cancer and a host of other illnesses. The Weight of the Nation premieres with two back-to-back one-hour shows May 14 and two more May 15, beginning at 8 p.m. ET/PT each night. It has a companion book by the same name.

The documentary, which also involved the Centers for Disease Control and Prevention and the National Institutes of Health, is being released in conjunction with a two-day CDC meeting, also called Weight of the Nation, May 7-8 in Washington, D.C. Hoffman offers his thoughts on the series and its message in this conversation:

Q: What is it going to take to reverse the obesity epidemic?

A: The obesity epidemic is not a natural disaster that we can’t do anything about. This national crisis is completely preventable.

We live in a world where there’s an abundance of cheap calories, and we have foods high in sugar and fat at arm’s reach at almost all times.

Big decisions made by the food industry, agriculture and government have a huge impact on the little decisions we make about what we reach for when we’re hungry and how long we sit at our desks and in our cars.

Q: What was the most surprising thing you learned?

A: Over the course of human evolution, there has never been any reason to limit our food intake. In fact, it’s the opposite. Because we need food to survive, we are genetically programmed to love it. There may be as many as 100 genes that favor food-seeking behavior. And we evolved a system to favor fat deposition as a buffer against times of scarcity. … But in a world full of burger joints, pizza parlors and vending machines, our biological imperative to store fat whenever we can may instead pose a threat to our survival.

Q: If you could wave a magic wand and make a change, what would it be?

A: Remove all sugared beverages from our diet. Our bodies are not adapted for that rush of liquid calories. It’s clear they’re driving a lot of obesity and a contributor to diabetes.

Q: What else did you learn?

A: Even after 10 years of maintaining a significant weight loss, the body doesn’t readjust. Your brain still thinks you’re in a state of deprivation, and it manipulates your body in ways you don’t even notice: You’re hungrier, less easily satisfied, and more frequently tempted by sweet and fatty foods; you are less inclined to exercise.

Losing weight and keeping it off requires a renovation of your entire life for the remainder of your life.

Q: What actions/policies would help the most?

A: We need to work together to make some big changes to the systems that govern the food we grow; the economies that drive the food we manufacture; the policies that regulate what we market and serve, particularly to kids; the values we place on the overall quality of the schools to which we send our children; the design of our communities, parks and roads so they promote health; and the perspective of our health care system so that it’s focused on preventing illness from happening, rather than just treating it once it develops.

http://www.usatoday.com/news/health

Legislation that will require insurance companies to offer coverage for autism treatments has been signed into Michigan law.

Lt. Gov. Brian Calley signed the measures Wednesday. Gov. Rick Snyder is in Afghanistan.

Lawmakers gave final legislative approval to the measures last month.

Snyder supported the legislation that was championed in part by Calley, who has a daughter with autism.

Previous efforts to mandate insurance coverage for autism had failed in Michigan. But a bill backed by Senate Majority LeaderRandy Richardville helped soften opposition by setting up a fund to help reimburse some companies for paid claims related to diagnosis and treatment of autism.

A majority of states already have laws aimed at requiring insurance companies to cover some types of autism therapies.

http://www.annarbor.com/news/

* Republicans pledge new health plan if Supreme Court acts

* New legislation could aid party’s election year aims

* Aides see step-by-step approach on health issues

By David Morgan

WASHINGTON, April 22 (Reuters) – Republicans in Congress are getting ready to answer an election-year question that has dogged the party’s campaign for months: How would it replace President Barack Obama’s healthcare law if the measure is overturned or repealed?

House Republicans are working to create a legislative blueprint they can sell to voters after the Supreme Court rules on Obama’s Patient Protection and Affordable Care Act, the nation’s most sweeping healthcare legislation since Medicare and Medicaid in the 1960s.

Lawmakers and their aides say a Republican plan would focus on controlling healthcare costs and allowing people to retain coverage while changing jobs. They will avoid Obama’s comprehensive approach to extend coverage to 32 million uninsured Americans.

The aim is to lay out a prospective agenda for the newly elected political leadership in 2013, based on a “step-by-step” approach consisting of separate bills that address specific problems within America’s $2.6 billion healthcare system.

But if the high court justices struck down the entire law, Republicans could try to salvage some of the Affordable Care Act’s provisions that are already in force and have proved popular with voters.

Representative Tom Price, an orthopedic surgeon who heads the House Republican Policy Committee, said stopgap legislation could be crafted for 2012 if the court ended health insurance safeguards for young adults and children with pre-existing medical conditions.

“That would present a significant void and vacuum in health policy,” Price said. “There will be a need to have some things to fill that vacuum.”

But a Senate Republican aide said there would be no need for Congress to act this year if necessary adjustments could be achieved by the administration alone or by industry.

“There’s a lot of shadow-boxing going on,” said one healthcare industry lobbyist.

Closed-door discussions have not yet turned to specific legislative options, w hich may be drawn from a swath of previously proposed Republican legislation. But some say a consensus between leaders and key committee chairmen could emerge as early as the May 28 Memorial Day holiday, weeks before a Supreme Court ruling widely anticipated for June.

“When the Supreme Court acts, we will be ready with plans that actually work to lower the cost of care and to help people keep the care they want,” said Republican Senator John Barrasso, another orthopedic-surgeon-turned-legislator who is Price’s policy counterpart in the Senate.

A DEMOCRATIC PLAN, EVENTUALLY

The Affordable Care Act , Obama’s signature domestic achievement, introduces new consumer protections and encourages market innovations intended to improve the quality of care while eventually lowering costs.

But 26 states and an independent business group asked the Supreme Court to overturn the law on grounds that it exceeded the federal government’s constitutional authority by requiring most Americans to buy health insurance and imposing a dramatic expansion of the federal-state Medicaid program for the poor.

The court’s impending decision, which would land in the middle of the 2012 campaign battle for control the White House and Congress, could strike down all or part of Obama’s reform act, or leave the two-year old package in place.

Whatever the outcome, the decision is expected to kick off an aggressive new chapter in the election campaign that will spotlight healthcare far more prominently, according to analysts and lobbyists.

There has been no word on whether House Republicans are consulting with the party’s presumptive presidential nominee Mitt Romney, who has proposed his own set of market-oriented healthcare reforms and has vowed to kill Obama’s healthcare law.

Up to now, Republicans on the campaign trail have chiefly attacked “Obamacare” and vowed to repeal it, leaving them vulnerable to charges the party has no credible reform plan of its own.

“They need something positive. ‘Repeal’ alone is negative, and people want consequential health reform that solves real problems that are facing them,” said Robert Moffitt of the Heritage Foundation, a conservative think tank that has contributed reform ideas to both sides of the partisan aisle.

Moffitt and James Capretta of the conservative American Enterprise Institute advocate an approach they say would make consumers more cost-conscious.

It would move away from the current tax break for employer-sponsored healthcare, in exchange for fixed tax credits that would help cover the cost of individual plans sold in a competitive marketplace. Consumers would have to bear any cost over the fixed tax credits.

In an article titled “How to Replace Obamacare,” in the current edition of the quarterly journal National Affairs, the two analysts also call for changing existing laws to protect people with pre-existing conditions and adopting policies that would better encourage reform initiatives at the state level.

Similar ideas and others have been circulating for years in Republican legislative proposals that have never become law.

Some call for insurance reforms allowing individuals to buy insurance from other states or for letting small businesses, churches and civic organizations form new insurance pools.

Proposals also would protect doctors and other healthcare providers from malpractice suits and convert Medicare into a program that provides vouchers to help the elderly and disabled meet the cost of purchasing private insurance.

But some of those ideas have been found wanting in the past.

In 2009, the nonpartisan Congressional Budget Office examined a Republican proposal that sought to allow the interstate sale of insurance, imposed medical malpractice reforms and offered incentives for state-level reforms.

The CBO found the plan would cut the deficit by $68 billion over 10 years, extend coverage to only 3 million uninsured and raise insurance rates for some, including those less healthy.

By contrast, the CBO has said the Affordable Care Act would reduce the deficit by $132 billion through 2019.

The Obama administration is also showing signs of thinking about what to do if the Supreme Court’s ruling proves unfavorable.

Officials still say they are confident the Affordable Care Act will be upheld and that their focus is on implementing its provisions. But references to “a plan” have begun to emerge in recent comments by the White House and the Department of Health and Human Services.

“We will eventually, I’m sure, have a plan. But that really isn’t where all the time and energy is focused right now,” Health and Human Services Secretary Kathleen Sebelius told Reuters after a recent speaking engagement. (Additional reporting by Thomas Ferraro; Editing by Michele Gershberg and Peter Cooney)

http://www.reuters.com/article/

By James GallagherHealth and science reporter, BBC News

Manipulating memories of drug use may help reformed addicts avoid a return to a life of drug abuse, according to scientists in China.

They said memories linking “cues” – such as needles or cigarettes – and the pleasurable effects of drugs caused cravings and relapsing.

Authors of the study, published in the journal Science, “rewrote” those memories to reduce cravings.

Experts said targeting memories could become a new avenue for treatment.

Repeatedly showing people drug cues without actually giving patients the drug is a part of some therapies for addicts. It can break the link between cue and craving in the clinic. But this does not always translate to real life.

The researchers at Peking University tried to rewrite the original memory so that it would be as if the link between cue and the craving never existed.

Flexible memories

The work relies on the idea that a memory can become malleable after it is accessed, creating a brief window during which the memory can be “rewritten”.

“I’m quite excited by this research… It could be really important for treatment of addiction”

Twenty-two heroin addicts who had not taken the drug for – on average – 11 years, took part in the study.

They were initially shown a brief video to remind them of taking drugs – opening the memory window. Ten minutes later they watched more videos and looked at pictures of heroin drug use.

Other addicts were shown an initial video of the countryside, which would not open the window.

Tests 180 days later showed that levels of cravings were lower in those treated during the ‘memory window’ than in the other groups. These experiments were backed up by further tests on “addicted” rats.

The authors wrote: “The [memory] procedure decreased cue-induced drug craving and perhaps could reduce the likelihood of cue-induced relapse during prolonged abstinence periods.”

Dr Amy Milton, who researches memory and addiction at the University of Cambridge, said: “I’m quite excited by this research.”

She said it was “such a minor” difference from current therapies which “tapped into an entirely different memory process” and the reconstruction of the original memory.

“Full clinical studies are needed, but it could be really important for treatment of addiction,” she said.

Dr Milton added: “There is no theoretical reason it couldn’t apply to other addictions such as alcohol. That’s obviously very exciting.”

http://www.bbc.co.uk/news/health-17689645

By Julie Appleby, Kaiser Health News

Once a year, employees of the Swiss Village Retirement Community in Berne, Ind., have a checkup that will help determine how much they pay for health coverage. Those who don’t smoke, aren’t obese and whose blood pressure and cholesterol fall below specific levels get to shave as much as $2,000 off their annual health insurance deductibles.

At Chicago-based Jones Lang LaSalle, a real estate firm, workers can earn up to $300 in cash for having a physical and hitting certain medical goals, or completing health coaching programs.

Gone are the days of just signing up for health insurance and hoping you don’t have to use it. Now, more employees are being asked to roll up their sleeves for medical tests — and to exercise, participate in disease-management programs and quit smoking to qualify for hundreds, even thousands of dollars’ worth of premium or deductible discounts.

Proponents say such plans offer people a financial incentive to make healthier choices and manage chronic conditions such as obesity, high blood pressure and diabetes, which are driving up health care costs in the USA. Even so, studies of the effect of such policies on lifestyle changes are inconclusive. And advocates for people with chronic health conditions, such as heart disease and diabetes, fear that tying premium costs directly to test results could lead to discrimination.

Employee reaction has also been mixed. “It’s an invasion of privacy,” says Bradley Seff, 54, a court reporter who in August 2010 filed a lawsuit against his employer,Broward County, Fla., for introducing such a plan.

Nonetheless, such plans appear to be the wave of the future. Faced with crippling health care costs, the number of employers embracing such programs inched up from 49% in 2010 to 54% last year — and more say they expect to do so soon, according to a survey by consultants Aon Hewitt. Big-name participants include insurer UnitedHealthcare, car rental firm Hertz, postage meter maker Pitney Bowes and media owner Gannett, owner of USA TODAY. More employers are expected to adopt them starting in 2014, when the health law — if the Supreme Court upholds it — would allow them to offer larger incentives or penalties.

“We’re seeing a big move in this direction driven by employers’ concern about rising health costs and their sense that employee behavior has a lot to do with high costs,” says Kevin Volpp, a professor at the University of Pennsylvania School of Medicine, who has studied the use of such incentives.

Cost savings seen

Leaders at Swiss Village credit their 8-year-old wellness program, along with a high-deductible insurance plan and an on-site fitness center, with slowing health care cost increases. Indeed, workers saw no increase in premiums from 2005 to 2011.

“We continue to embrace what we’re doing,” says Daryl Martin, executive director of the non-profit organization. Even so, a few high-cost medical issues among its 230 covered employees and their dependents last year caused Swiss Village to raise employee costs 14% this year. What’s important, Martin says, is that the company’s approach keeps health “at the forefront of what people are thinking about.”

Of the employers who offer such programs, about one-third offer financial incentives to those who undergo specific medical tests, according to the Aon Hewitt survey. And 5% of those tie the financial rewards or penalties to meeting specific medical-based standards. The survey also found an expansion of such tests is on the horizon: 57% of employers said they planned to add incentives for spouses and dependents in the next three to five years.

“A lot of costs come from spouses, but only 29% had incentives for spouses,” says Cathy Tripp, a senior vice president at Aon.

Employers will still have to craft plans to comply with federal and, in some cases, state requirements, Volpp says. The programs must be voluntary — meaning an employer can’t require a worker to participate as a condition of coverage — and the employer must offer a “reasonable alternative” to qualify for the reward, or to avoid the penalty for those who can’t achieve the goals.

But Dick Woodruff, vice president of federal relations for the American Cancer Society Cancer Action Network, worries that there’s no definition of what a reasonable alternative must include.

Some workers also complain that the programs are an intrusion into their private lives.

“They portrayed it as voluntary, which it isn’t, because if you don’t participate, they fine you every paycheck,” says Seff, the former Broward employee who is suing over the program. He has since retired on disability with back and neck problems. “I don’t think any employer should do it.”

In an effort to slow rising costs, Broward County in 2009 began asking workers to fill out a health information form and have a finger-stick blood test each year to check blood sugar and cholesterol levels, according to court filings. Workers who declined were docked $40 a month. Those who participated were offered disease-management programs if they had asthma, high blood pressure, diabetes, congestive heart failure or kidney disease. The county stopped docking those who declined to participate Jan. 1, 2011, after Seff’s lawsuit was filed, court documents show.

The lawsuit, which argues that the county’s program violates the Americans with Disabilities Act, is likely the first of its kind in the nation, says Seff’s attorney, Daniel Levine in Boca Raton, Fla. Without ruling on whether the wellness effort was voluntary, a federal district court judge backed the county in April of last year, saying the plan fell under provisions of the law meant to protect bona fide benefit programs. The case is now on appeal. Broward County attorneys did not return requests for comment.

Some state lawmakers are also concerned about the potential for discrimination. Colorado passed legislation in 2010 that requires wellness programs to be accredited, bars penalizing workers for not participating or failing to meet a health standard — and allows appeals if an employee is denied an alternative. A similar bill was brought unsuccessfully in California last year, according to a February report by Georgetown University’s Health Policy Institute.

Concern for consumers

While supporting wellness programs in general, several patient advocacy groups warned the Obama administration last March that additional consumer protections are needed. Tying medical test results to financial incentives or penalties in premiums or deductibles could discriminate against some workers, especially those who already have health problems, the groups said.

“When you start increasing premiums or pumping up the deductibles, you’re making it more expensive and harder for people to access insurance,” says the Cancer Society’s Woodruff, who adds that offering gift cards or bonuses are a better way to reward people for participation.

Employers argue, however, that since they’re on the hook for the bills, they can ask workers to take more responsibility.

“House money, house rules,” says Ken Sperling, global health care practice leader at Aon Hewitt.

The first worker wellness programs, which began about a decade ago, rewarded simple participation: attending a health fair or filling out “health risk assessments,” with the worker perhaps receiving a $25 gift card in return.

Today, many offer discounted premiums to workers who meet standards related to blood pressure, cholesterol and weight, with the value of those discounts running between $30 and $60 a month, says Jim Pshock, founder and CEO of Bravo Wellness in Avon, Ohio. Bravo administers such programs for about 220 employers nationwide, including Colorado construction firm Oakwood Homes and Nashville’s Ardent Health Services.

Although employers may set specific goals — such as a body mass index (BMI) below 30, the level considered obese — many also reward achievement of less daunting targets. One employer rewarded workers if their test results didn’t worsen, Pshock says.

At Swiss Village, workers get $500 off their deductible for each of these measures: not smoking, having a BMI of 27.5 or less, a low-density lipoprotein cholesterol level (LDL) of 130 milligrams per deciliter or less, and blood pressure of 130/85 or less. LDL levels above 129 are associated with higher risk of heart disease, while blood pressure greater than 120/80 is considered a risk factor for heart attack and stroke.

A second tier of awards allows employees who approach those ranges to earn $250 per category. The testing takes place at an on-site health fair or at a doctor’s office, with the results gathered by an independent insurance firm that runs the company’s program.

The information is generally gathered by firms that run wellness programs or insurance plans. UnitedHealthcare, which offers its “Personal Rewards” program to large, self-insured clients, says it does not use the information to set premiums.

But do they work?

Given the available data, it’s hard to parse how much of the reported savings from such programs come from improved health, and how much from the frequent pairing of such programs with high-deductible policies.

“We just don’t know how effective (incentives) are,” Volpp says. There is pretty good evidence they help smokers quit, he says, but less that they prompt workers to lose weight and keep it off.

Volpp says the medical literature shows they work best when participants have choices: get below a certain BMI, or lose 5% of current body weight, for example. And, he says, rewards should be immediate. “If you want the employee to do a health assessment or (medical) screening, you should give them the reward right after they do it,” Volpp says.

At Jones Lang LaSalle, workers who make a pledge — on the honor system — that they don’t smoke, or will take a stop-smoking class, and achieve a healthy weight, get 10% off their contribution toward insurance premiums.

In 2010, the firm added a cash bonus program, offering $50 to workers who get a physical and another $50 for every one of four medical tests they take: weight, blood pressure, glucose and cholesterol, plus an extra $50 if they do all the tests. If they meet specified goals — or complete a coaching program — they receive the money as a cash bonus. Spouses and domestic partners are also eligible, says Howard Futterman, senior vice president of benefits.

Last year, 65% of employees participated. While it’s early, he says, indications are the program is having an impact on costs: Health spending rose 6% in 2010, but only 3% in 2011.

“Our long-term goal is to make health and well-being part of our culture and everyday values,” Futterman says. “When people start doing it naturally and you don’t have to pay them for it, that’s when you know you’ve succeeded.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a non-profit, non-partisan health policy research and communications organization not affiliated with Kaiser Permanente.

http://www.usatoday.com

Offering free nicotine patches or intensive counselling to smokers calling the English NHS helpline does not help them quit, a study in the BMJ says.

University of Nottingham researchers found that this additional support – on top of what is already offered – had no effect on numbers giving up smoking.

More than 2,500 smokers were followed up over one year.

The Department of Health said it would not now offer any extra services.

The Department of Health and the UK Centre for Tobacco Control Studies, in Nottingham, funded the study to find out if the support offered currently by the NHS Smoking Helpline could be improved.

‘Proactive support’
The smokers in the study were split into four groups.

The first received standard support in the form of NHS Stop Smoking Services advice, letters, emails, text messages and access to a helpline.

The second group received the same support but were also offered free nicotine replacement therapy (NRT) in the form of a 21-day supply of patches.

The third group received “proactive support” in the form of standard support plus extra counselling sessions and messages from helpline staff.

The fourth group received the same proactive support as the third group but with added free nicotine patches.

Participants in the study were followed up one month and six months later.

Analysis of the data showed that six months after quitting, 18.9% of the 59% who were contacted said they had managed not to smoke.

Nearly 80% of this group agree to give a breath test for carbon monoxide to prove that they had stopped smoking.

The study found no significant difference in success rates between those people offered different types of supportive counselling, or between those given nicotine replacement therapy.

Some 18.2% of those given proactive support had quit, compared with 19.6% of those who did not receive this support.

Overall, 17.7% of smokers who were offered the patches stopped smoking, compared with 20.1% of those not offered them.

Even one month after setting a quit date, no significant differences were found between the groups.

‘Costly burden’

Professor Tim Coleman of the UK Centre for Tobacco Control Studies, who led the study, said the trial had shed light on how telephone helplines could be used to help smokers who wanted to stop.

“On the basis of this study, giving out free nicotine patches and more intensive telephone counselling through the English national quitline just doesn’t seem to work.

“It brings into sharp relief the need to find other ways of using quitlines to help smokers give up, and so to reduce the terrible effects smoking has on people’s lives and the costly burden to the NHS.”

Amanda Sandford, from Action on Smoking and Health (Ash), said the study showed that standard NHS care was difficult to improve upon.

“We are fortunate in having a wide range of treatments available in this country which can be tailored to the individual needs of the smoker.

“The important thing is that people wanting to stop smoking should get professional advice.

“The 17-20% quit success rate found in this study is far higher than when trying to stop smoking on your own.”

A Department of Health spokesman said the research was helpful in deciding what the helpline should offer.

“The Coleman study looked at what would happen if the helpline also offered extra services to smokers such as free nicotine patches. It found that there would be little additional benefit so we won’t be adding this to the helpline.”

http://www.bbc.co.uk/news/health-17475241

Health reform is different.

We met Nathan and his son, Thomas, in 2009. Thomas was born with hemophilia, and he hit lifetime limits on his health coverage with two different insurance companies before he turned seven years old. Two years ago, Nathan was hopeful about what the Affordable Care Act would mean.

Last week we spoke with Thomas’s family again and they made it clear: Health reform has improved their quality of life. It means they can focus on making sure Thomas has the best possible care. It’s changing their lives for the better.

Thomas is not alone. He’s just one of the 105 million Americans who no longer have lifetime dollar limits on their coverage.

The Affordable Care Act gives hardworking, middle class families the security they deserve. Because of health reform, 54 million Americans with private insurance have been able to access more preventive services. In the 2011 tax year, two million workers will benefit from the small business health insurance tax credit. And 2.5 million young people under age 26 have gained coverage on their parents’ plan.

Behind each of those numbers is a person like Thomas. Two years after President Obama signed the Affordable Care Act, life is a little better for millions of Americans from all over the country.

So take a moment to hear some of their stories and hear why this matters for Americans across the country:

http://links.whitehouse.gov/track?

One in three adults aged over 65 in England have difficulty understanding basic health-related information, suggests a study in the BMJ.

They are more than twice as likely to die within five years as adults with no literacy problems, it was found.

The University College London study tested nearly 8,000 adults on their understanding of aspirin instructions.

The Patients Association said patients should help draft information leaflets so they are “relevant and clear”.

The researchers, from the department of epidemiology and public health at University College London, said that limited or low health literacy among older people has implications for the design and delivery of health services for this section of the population.

Using a short test containing four questions, based on instructions similar to those found on a packet of aspirin, the researchers assessed the participants’ ability to read and understand the information.

They found that 67.5% had high health literacy (achieved the maximum score), 20% were classed as medium (made one error) and 12.5% had low health literacy (got two, one or no questions correct).

In the study, almost half of the adults aged over 80 could not correctly answer all four questions, compared to one-quarter of the adults aged 60 or less.

‘Worrying’

The study followed the participants for an average of five years after the test.

During this time, 6.1% (321) died in the high health literacy category, 9% (143) in the medium category and 16% (157) in the low literacy category.

The researchers said that lower health literacy was linked to a higher prevalence of depressive symptoms, physical limitations and chronic diseases, such as heart disease, diabetes, stroke and asthma – but higher health literacy scores were linked to stronger cognitive abilities, including verbal fluency and working memory, they said.

When researchers adjusted for factors such as wealth, education, income, ethnicity and basic health, the link between low health literacy and mortality risk reduced, “but remained significant”, the study said.

Katherine Murphy, chief executive of the Patients’ Association said it was worrying that so many people struggle to understand health-related information.

“How are patients expected to make informed decisions if they do not fully understand the information being given to them?

“Patients must be involved in the development of these information leaflets from the outset to make sure they provide relevant and clear information.”

Michelle Mitchell, director general of Age UK, said health professionals have a responsibility to give patients information that makes sense.

“That way, patients will be better empowered to manage their own health conditions and make the positive lifestyle choices that lead to better health and wellbeing.”

http://www.bbc.co.uk/news/health-17381926